Healthcare Provider Details

I. General information

NPI: 1164808796
Provider Name (Legal Business Name): MADISON BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16870 EAST RD STE 400
MONTROSE MI
48457-9370
US

IV. Provider business mailing address

16870 EAST RD
MONTROSE MI
48457-9370
US

V. Phone/Fax

Practice location:
  • Phone: 810-771-8458
  • Fax:
Mailing address:
  • Phone: 810-771-8458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY ALLAN KIMEL
Title or Position: OWNER
Credential:
Phone: 810-771-8458